Trends In Inequality Research Articles

Intersectional trends in poor mental health and health inequities across the US

Though mental distress poses a large and growing threat to population health, our understanding of how its social distribution has changed over time and what these changes imply for mental health equity is limited. To address this, we use data from the Behavioral Risk Factor Surveillance System to non-parametrically describe how age-standardized prevalence of frequent mental distress (FMD) and social inequities in FMD have changed in the United States between 1993 and 2019 for intersectional social groups defined by ethnicity, race, sex, educational attainment, and household poverty status. We find that age-standardized FMD prevalence has increased for almost all social groups, that health inequities between more and less privileged groups have mostly widened in absolute terms but narrowed relatively, and that relying solely on common group FMD summaries masks substantial heterogeneity across intersectional subgroups. Our findings show an urgent need to address the sociopolitical determinants of mental distress, prioritizing policies which would address the growing inequitable burden experienced by those less privileged.

Bibliometric and Content Analyses of Research Trends in Mobility Inequality

Bibliometric and Content Analyses of Research Trends in Mobility Inequality

Population-level trends over a decade in geographical inequality for opportunity in access to maternal care services: a cross-sectional analysis from the National Family Health Surveys in India

ObjectivesThe objective of this study is to examine the trends in geographical inequality of opportunity in maternal health services in India considering the Every Newborn Action Plan (ENAP) 2025 coverage...

Analysis of Trends in Immunization Coverage Inequalities Among Children Aged 12–23 Months in Guinea: Data from Demographic and Health Surveys in 2005, 2012, and 2018

Background: The aim of this study was to describe trends in inequalities in full immunization of children aged 12 to 23 months and to identify associated socioeconomic factors. Methods: A secondary analysis was carried out using data from three Demographic and Health Surveys (DHS) conducted in 2005, 2012 and 2018 in the Republic of Guinea. The concentration, or Lorenz curve, and associated index were used to measure inequalities over time. Multivariate logistic regression was employed to identify socioeconomic factors associated with full vaccination of children aged 12 to 23 months. Results: The study found a strongly positive overall concentration index (CI > 0.5) for complete vaccination of children aged 12 to 23 months, indicating inequalities in favor of wealthier households. This inequality decreased in 2012 but increased again in 2018. Children from wealthy families were nearly twice as likely to be fully vaccinated compared to children from very poor families (adjusted OR 1.79, 95% CI: 1.38 - 2.32). Conclusion: This study revealed significant inequalities favoring wealthy families in the use of immunization services by children aged 12 to 23 months in Guinea. It also underscores the need for planning and implementing strategies to reduce these inequalities in access to and use of immunization services.

Trends in maternal education-based inequalities in under-five mortality in Ethiopia: multilevel, decomposition and concentration index analyses

IntroductionIn 2021, a staggering five million children globally succumbed to mortality before celebrating their fifth birthdays. Alarmingly, children residing in Sub-Saharan African nations faced mortality risks 15 and 19 times higher than their counterparts in Europe and Northern America, as well as the region encompassing Australia and New Zealand, respectively. Ethiopia, situated in Sub-Saharan Africa, shoulders a significant burden of under-five mortality, securing the third position in Africa and the tenth globally. The primary objective of this study was to scrutinize the trends in under-five mortality inequalities based on maternal education in Ethiopia from 2000 to 2016.MethodThe analysis utilized data from repeated cross-sectional surveys, drawing upon a pooled total sample of 35,404 children aged 0–59 months. This sample was derived from the Ethiopian Demography and Health Surveys conducted in 2000, 2005, 2011, and 2016. To explore the determinants of under-five mortality among this age group, we employed multilevel binary logistic regression analysis. This approach allowed us to assess the impact of various factors at the individual, household, and community levels. Additionally, we conducted multivariate decomposition, concentration index, and decomposition rate analyses to scrutinize the evolving trends in maternal education-based disparities in under-five mortality.ResultMaternal education emerged as a significant factor influencing under-five mortality in Ethiopia. Notably, approximately one-third (31%) of the observed inequalities in under-five mortality based on maternal education could be accounted for by the effects of observed characteristics. Over the years, there has been a noteworthy reduction in absolute inequalities in under-five mortality. Specifically, a decline of 0.14 was observed between 2000 and 2005, and a more substantial decrease of 0.32 occurred in the period spanning 2000 to 2016, resulting in an overall change of 56.25%. Furthermore, this study revealed that about 43.12% of the reduction in under-five mortality could be attributed to the narrowed gap in maternal education during the survey period.ConclusionThe implications drawn from these findings underscore the importance of directing interventions aimed at reducing early mortality toward the promotion of maternal education. It is evident that addressing maternal education plays a pivotal role in mitigating inequalities in under-five mortality. Additionally, there is a pressing need to revisit and enhance existing population and health policies. Establishing stronger linkages between child survival issues and the education sector is crucial for achieving the targets outlined in the Sustainable Development Goals related to under-five mortality. By aligning policies with these insights, there is a greater likelihood of fostering sustainable improvements in child survival and advancing towards the overarching goal of reducing under-five mortality.

Trends in socioeconomic inequalities in cardiometabolic risk factors: Analysis of the repeated cross-sectional Health Surveys for England between 2003 and 2019

BackgroundNon-communicable diseases (NCDs) are the leading cause of death and disability globally, accounting for 89% of all deaths in the UK with the most significant cause being from cardiovascular diseases (CVD). The risk of NCD mortality and morbidity is highest for individuals in the most deprived socio-economic positions (SEPs). Cardiometabolic risk factors are the main risk factors for mortality from NCDs including CVDs but limited studies have examined recent trends in inequalities in these risk factors. This study examines national trends in inequalities of four key cardiometabolic risk-factors and their co-occurrence in England from 2003–2019. MethodsThis time-trend analysis used sex-specific, repeated cross-sectional self-reported and examination data from adults aged ≥16 years (N=155 226), from pooled nationally representative Health Survey for England 2003–2019, collected via trained interviewers and nurses in participants’ homes. Log-gaussian regression models were used to examine the relative index of inequalities (RII) and slope index of inequalities (SII) in four cardiometabolic risk factors: obesity, hypercholesterolaemia (using total cholesterol, for comparability with similar studies using same data source), hypertension and diabetes, and their co-occurrences, using four different indicators of SEP (area deprivation, education, equivalised household income and occupational status). FindingsFrom 2003 to 2019, hypercholesterolaemia and hypertension prevalence decreased significantly for both sexes, while obesity increased and diabetes remained stable. Lower SEPs consistently had higher prevalence of obesity, hypertension and diabetes, but lower prevalence of hypercholesterolaemia for both sexes. For women, relative (p=0·011) and absolute (p<0·001) inequalities in obesity by neighbourhood deprivation and absolute inequality by equivalised income (p=0·033) widened, with those in lower SEP reporting higher prevalence. For hypertension, relative inequality by education widened for men (p=0·036) while absolute inequality by education narrowed for women (p=0·009). Women also experienced widening inequalities in hypercholesterolaemia for most SEP measures, but favouring those in lower SEPs. For co-occurrence of risk factors, women saw a narrowing of inequalities by education (relative and absolute) and income (absolute). InterpretationsStructural interventions targeting lower SEPs are necessary to address these trends in inequalities in England. The continued increase in obesity prevalence and widening of both absolute and relative inequalities in women by neighbourhood deprivation requires urgent action. FundingThe Health Survey for England was funded by NHS Digital (now NHS England). This study received no specific funding.

Cross-National Trends in Adolescents Psychological and Somatic Complaints Before and After the Onset of COVID-19 Pandemic

PurposeBuilding on research suggesting that the COVID-19 pandemic may have led to an exacerbation of deteriorating trends in mental health among adolescents, this paper examined trends in adolescents' psychological and somatic complaints across 35 countries from 2010 to 2022, and tested trends in sociodemographic inequalities in these outcomes between 2018 and 2022. MethodsUsing data from 792,606 adolescents from 35 countries (51% girls; mean age = 13.5; standard deviation 1.6) across four Health Behaviour in School-aged Children surveys (2010, 2014, 2018, 2022), hierarchical multilevel models estimated cross-national trends in adolescent psychological and somatic complaints. We tested whether observed values in 2022 were in line with predicted values based on 2010–2018 linear trends. Finally, moderation effects of age, family affluence, and family structures on the outcomes were tested (2018–2022). ResultsBoth girls and boys showed substantially higher levels of psychological complaints in 2022 compared with the predicted values. For somatic complaints, higher levels than predicted in 2022 were observed only in girls. Moderation analyses revealed an increase from 2018 to 2022 in age gaps and a narrowing in the socioeconomic gap for both outcomes. Also, there was a widening gap between adolescents living with 2 parents and those living in a single parent household in 2022 compared to 2018. DiscussionCross-national increases in adolescent psychological and somatic complaints were higher than expected in 2022, based on previous trends. Magnitudes of change varied across different sociodemographics groups, with implications for pre-existing mental health inequalities.

Mapping inequalities in health service coverage in Africa: a scoping review

ObjectiveIn this scoping review, we aim to consolidate the evidence on inequalities in service coverage in Africa using a comprehensive set of stratifiers. These stratifiers include place of residence, race/ethnicity/culture/language,...

Toward Common Prosperity: Measuring decrease in inequality in China prefecture-level cities

To resolve the ongoing debate on the trajectory of inequality in China and to quantitatively measure China’s progress toward the goal of common prosperity, this study proposes a novel approach based on Revealed Comparative Wealth (RCW). Tailoring RCW to national levels to study China prefecture-level cities, a salient pattern of widespread convergence to the national mean since 2003 is observed, signifying an extensive reduction in economic inequality across China prefecture-level cities. Building on this observation, a modified Gini coefficient, Ginicity, is proposed, which shows that China’s inter-city economic inequality reached its zenith in 2003 and has since been declining. A new Theil’s T formulae is also derived based on RCW to corroborate this finding. The declining inequality trend can be largely attributed to two key mechanisms: (1) the implementation of the “Common Prosperity” policy framework, which includes numerous targeted assistance policies from both central and local governments aimed at fostering a more balanced and equitable economic landscape, and (2) the process of urbanization, which exacerbated inequality in 1980s and 1990s during China’s first stage of economic reform, has facilitated the sharing of added wealth with an influx of population into economically thriving cities since 2000. The developmental strategies of China may offer valuable insights for other developing countries pursuing economic equality and growth simultaneously.

사교육비 불평등도에 대한 연구: 사교육비 지니 계수, 후버 지수, 팔마 비율을 중심으로

Objectives This study aims to find a way to measure the degree of inequality in private education expenditures in Korea and to analyze trends in inequality. Methods We analyzed the private education expenditures survey conducted by the Ministry of Education to find an index that indicates the inequality of private education expenditures, and obtained each index by year to under-stand the trend. Results The average private education expenditures per person is increasing, and the analysis of private education expenditures inequality using the Gini coefficient, the Hoover index, and the Palma ratio shows that inequality is increasing, especially in elementary schools. In 2020, during the COVID-19 situation, the private education Gini coefficient increased rapidly as the private education participation rate decreased in elementary and middle schools, but this phenomenon was not found in high schools. Conclusions The Gini coefficient, Hoover index, and Palma ratio, which indicate the degree of inequality in private education, can be obtained for the entire population and participants, but considering that the case where private education expenditures are 0 has a significant impact, it may be more appropriate to limit it to participants. The Gini coefficient, which indicates income inequality, is on the decline, but the Gini coefficient for private education expenditures for participants is increasing, and since private education is linked to the problems of low birth rate and local extinction that our society faces, special measures are needed to reduce private education.

Inequality of Labor Income in Kazakhstan’s Regions: Trends, Causes and Opportunities for Reduction

In the modern world, income inequality is growing, the share of labor income is decreasing, and the problems of overcoming poverty and equalizing people’s living standards have become acute. The article aimed to study trends in regional and sectoral inequality of labor income in Kazakhstan, identify contradictions and causes of their differentiation, and develop recommendations for reduction. The hypothesis: the assumption that the size of regional inequality of labor income depends on the sectoral specialization of the regional economy. Tasks: review theoretical issues of income inequality, analyze wage trends in Kazakhstan’s regions and their primary industries, and develop recommendations to reduce income inequality. The proof/refutation of the hypothesis was carried out by assessing regional and sectoral differences in the labor incomes of Kazakhstanis and identifying their contradictions. The methods are generalization and concretization, comparisons and analogs, systematic approach, economic and statistical, comparative analysis, Pareto, and indicative. Information base: domestic and foreign scientists’ works, data from the Bureau of National Statistics of the Republic of Kazakhstan, and regional statistical services. Results: the methods of overcoming income inequality in world practice were identified; it was proved that despite wage growth, the share of labor income is decreasing; regional wage inequality in Kazakhstan in 2022 amounted to 2.3 times. It is recommended that regional inequality of labor income be reduced by introducing regional coefficients and shifting taxation from labor income to income from capital and property.

Socioeconomic inequalities in substance use among Norwegian adolescents between 2014 and 2022

Abstract Background Increasing use of substances is observed among adolescents in recent years. Early onset of substance use dramatically increases the risk of substance use disorder, dependence, and poorer psychological, social, and physical health, and is thus a public health concern. We explore trends in socioeconomic inequalities in past year use of cannabis and other illicit drugs between 2014 and 2022 among Norwegian adolescents. Methods This study is based on data retrieved from five waves of the nationwide Norwegian Ungdata survey (2014-2022) among adolescents attending upper secondary education (N = 282,259; 51 % girls). Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). Results The use of cannabis and other illicit drugs increased among boys (from 13% to 19%, and from 2% to 5%, respectively) and girls (from 8% to 14%, and from 1% to 3%, respectively) between 2014 and 2022. Higher prevalence’s was observed among the least affluence girls between 2020 and 2022, both in absolute and relative terms (SII: 0.01 to 0.06, RII: 0.97 to 1.52, p &amp;lt; 0.001). No inequalities were observed among boys during this time. While relative and absolute inequalities in use of other illicit drugs decreased in boys, absolute inequalities increased in girls. Boys were more likely than girls to have used cannabis and other illicit drugs, although the gender gap in cannabis use narrowed slightly during the study period. Conclusions Our data suggest increasing use of cannabis and other illicit drugs among Norwegian adolescent boys and girls between 2014 and 2022. Future studies should examine the potential causes of increasing substance use as a basis for understanding, and distinguishing between, the many intertwining factors that influence adolescent drug use behaviors. Key messages • The use of cannabis and other illicit drugs increased between 2014 and 2022 among Norwegian boys and girls. • While inequalities in the use of cannabis and ither illicit drug use increased in girls, small or no inequalities was observed among boys.

Social inequalities in the mental well-being of adolescents in Barcelona (2016-2021)

Abstract Crises have the potential to affect mental well-being (MWB), especially at vital stages of personal development such as adolescence. The objective of this study was to investigate the 2016-21 trends of social inequalities in the MWB of adolescents in Barcelona, stratifying by sex. Sequential, cross-sectional study based on the FRESC survey, held by the ASPB, representative of 8th and 10th grade adolescents (13-16 years old) schooled in Barcelona, in 2016 (N = 2,154) and 2021 (N = 2,299). MWB was examined using the validated WEMWBS, scoring from 14 (lowest) to 70 (highest) MWB. A temporal trend analysis of inequalities in MWB was carried out using the student socioeconomic status (SES) (low/average/high), measured with the validated FAS. For each group, the effect size of the WEMWBS means was measured with Cohen’s D. Linear regressions were performed, adjusting for academic grade, student country of origin, type of school and school index of vulnerable students. Adjusted β coefficients (aβ) and their statistical significance (p&amp;lt;.05) were estimated. In 2016, boys had higher MWB mean scores than girls (54.0 vs 50.8) (p&amp;lt;.01). In 2021, sex differences persisted, but with lower scores (51.7 vs 47.0) (p&amp;lt;.01) and still with a moderate effect size (0.52 in 2021 vs 0.40 in 2016). In multivariate regression models, boys in low SES showed the greatest MWB decrease in 2016 (low vs high SES: aβ= -3.44; p&amp;lt;.01). A significant temporal trend 2016-2021 of MWB worsening was observed in all groups, except for boys in low SES. The greatest deterioration in MWB was observed in girls, similarly in different SES (low SES: aβ= -3.52; p&amp;lt;.01). Boys in low SES showed the worst MWB in 2016 whereas all SES categories of girls had a significant trend of deterioration in MWB (2016-21). The latter could be attributed, among other factors, to a differential effect of the COVID-19 pandemic. These results underline the importance of addressing inequalities in the MWB, particularly among adolescent girls. Key messages • This study reveals a deterioration in mental well-being temporal trends (2016-2021) among adolescents in Barcelona, especially in girls. • Findings emphasize the need to address social inequalities for improving mental well-being outcomes in adolescent populations.

Temporal trends, regional and socio-economic disparities of colorectal cancer burden in Cyprus

Abstract Background Colorectal cancer (CRC) is one of the main causes of mortality and morbidity worldwide and it is the third most common cancer in Cyprus. Previous studies have documented variations in CRC burden over time, across regions and area-based socio-economic deprivation. The aim of this study was to analyse the burden of CRC over time, across regions and area-based socio-economic deprivation in Cyprus for the time period 2000 to 2015. Methods A small area ecological study was performed, with census tracts as units of spatial analysis. The incidence and death date, sex and age of CRC were obtained from the population-based cancer registry of Cyprus. Indirect standardization was used to calculate the sex and age Standardize Incidence Ratios (SIRs) and Standardized Mortality Ratios (SMRs) of CRC while the smoothed estimates of SIRs and SMRs were derived from the Spatiotemporal Bayesian Poisson log-linear model. To investigate temporal trends in the association between area-based socioeconomic deprivation and CRC burden, we have used the national socio-economic index. Results The burden of CRC was rising over time. The CRC cumulative incidence increase from 243.7 in the time period 2000-2007 to 347.3 per 100,000 persons in the time period 2008-2015.There was also a more pronounced geographical variation in SIR and SMR in the time period 2008-2015. Four areas out of 369 had smoothed SIR&amp;gt;1.15 while twenty-six areas had smoothed SMR&amp;gt;1.15, with most of those areas located at the east coast of the island and around the capital city. There was a temporal trend in the socio-economic inequalities of CRC burden. The areas in the third and fourth quartile of the socio-economic index had 23% and 45% lower rates of CRC incidence, and 33% and 47% lower rates of CRC mortality in the period 2008-2015. Conclusions These findings could shape national prevention policies, such as the national screening program of CRC starting in 2025 and protection strategies for CRC mortality. Key messages • Colorectal cancer screening should be geographically targeted for efficient resource allocation. • Public health interventions to improve colorectal-specific mortality risk should be geographically targeted.

Monitoring the level of health and inequality over time using the Population Health Performance Index

Abstract Background The Population Health Performance Index (PHPI) is a composite measure that combines average health outcomes and their distribution within a population, thereby allowing for a comprehensive assessment of population health and inequality. The aim of this study is to examine the extent to which the PHPI adds value to monitoring of health and inequality over time in comparison to absolute and relative inequality. Methods Data from the WHO Equity Monitor database on under-5 mortality disaggregated by wealth quintiles for Nepal, Ethiopia, Peru, Rwanda, and Zimbabwe were analysed using different years between 1994 and 2020. Descriptive comparative statistics were employed to assess trends in the PHPI and conventional pairwise measures of absolute and relative inequalities, with consideration of different weights for inequality aversion. Results PHPI trends correspond to the trend of absolute inequality in all five countries, although they exhibit less volatility over time. Relative inequality follows the trend of the PHPI in only two of the five countries (Ethiopia and Zimbabwe), reflecting the methodology utilised for the PHPI. PHPI scores vary based on different inequality aversion weights, highlighting the sensitivity of the index to methodological adjustments. Conclusions The PHPI demonstrates notable convergence of trends with conventional methods, thereby substantiating its utility as a comprehensive tool for the simultaneous measurement of health and inequality. As it is able to consider both absolute and relative inequality within its own calculations, the PHPI allows for independent analysis of its two key components. The PHPI facilitates a more nuanced understanding of population health and may be more easily understood by policymakers and other stakeholders. As it does not address the underlying causes of changes in health inequalities, further research is necessary to supplement monitoring activities. Key messages • PHPI is a valuable tool for health and inequality monitoring by integrating both average health and disparity in a single index, facilitating communication of trends over time. • The dual focus complements conventional methods with its multidimensionality and may enable stakeholders to assess health and inequalities in alignment with broader health policy objectives.

Exploring gender disparity in medicine: perceptions of female physicians in Lebanon

BackgroundGlobal research on gender bias has highlighted key trends in discrimination and inequality across various fields, including medicine. In Lebanon, a nation celebrated for its diverse cultural landscape and increasing female representation in medical education, there has been a notable absence of studies exploring gender dynamics in the medical profession.MethodsTo address this gap, we conducted a cross-sectional study using an online survey to explore the Lebanese population’s perceptions towards female physicians and the quality of care they provide.ResultsThe mean age of the study sample (n = 330) was 31.55 ± 10.07 years and included 114 females and 216 males. Most respondents had received care from a female physician. Notably, those who selected female physicians as their family doctors or had female doctors within their immediate family displayed a stronger tendency to engage in annual medical check-ups. While most respondents did not express any preference for the gender of their general practitioner or surgeon, there was a marked preference for female obstetricians/gynecologists, psychiatrists, pediatricians, and dermatologists. This preference was attributed to perceptions of female physicians being particularly compassionate, understanding, and proficient in communication.ConclusionThis study represents a groundbreaking contribution to understanding gender perceptions in the Lebanese medical field. It highlights the growing trust and positive regard for female physicians, underscoring the significant role in shaping healthcare experiences and outcomes in Lebanon.

Trends in socioeconomic inequality in e-cigarette use among adolescents in South Korea.

The global rise in e-cigarette use among adolescents is alarming, with associated socioeconomic inequalities posing potential public health risks. This study examined trends in the socioeconomic inequality in e-cigarette use among South Korean adolescents to inform future regulatory directions. Socioeconomic inequalities in e-cigarette use among Korean adolescents were assessed using data from the Korea Youth Risk Behavior Web-based Survey (KYRBS) from 2011 to 2023. The Concentration Index, a well-established method for measuring health inequalities, was employed. Additionally, this study investigated how the smoking behaviors of family members and friends influence socioeconomic inequality in e-cigarette use among Korean adolescents, using a decomposition analysis. The Concentration Index values showed a clear, fluctuating downward trend over 13 years, from -0.12 (95% CI: -0.13 - -0.10) in 2011 to -0.24 (95% CI: -0.26 - -0.21) in 2023. Decomposition analysis revealed that smoking among peer groups, including friends and siblings, was the primary contributor to socioeconomic inequality in e-cigarette use, followed by maternal smoking. Socioeconomic inequalities in adolescent e-cigarette use in South Korea are widening, particularly among low socioeconomic status groups. The impact of peer groups on socioeconomic inequalities in e-cigarette use among adolescents is concerning.

Social inequalities in adult mortality across Europe (18th-21st centuries): A critical analysis of theories and evidence

This study examines the historical evolution of socioeconomic disparities in adult mortality, with a focus on European societies. Despite the widespread improvements in population health, social inequalities in mortality are a pervasive phenomenon nowadays. This paper employs a critical analysis of both theoretical and empirical literature to investigate major international studies and their findings on longevity differences associated with socioeconomic status from the nineteenth century to the early twenty-first century. Findings reveal that adult mortality trajectories have differed notably across social classes and regions, with some areas exhibiting disparities before the demographic transition and others showing inequalities emerging later. Understanding these long-term health inequality trends sheds light on the changing influence of medical advances and their interplay with economic growth, educational disparities, environmental factors, state roles, and production distribution, which have shaped mortality disparities through different development stages. These factors elucidate the international heterogeneity of results until the mid-twentieth century and offer explanatory insights into observed north-south patterns in Europe. Our findings contribute to a deeper understanding of how advancements in public health, economic development, and social policies have shaped health outcomes over centuries. The implications of this research inform ongoing debates and health policy, emphasizing a nuanced interpretation of historical data to craft effective strategies that address health inequalities today.

Trends in intergenerational class mobility and education in Argentina, Chile, and Uruguay, over common birth cohorts

We compare intergenerational class mobility trends in Argentina, Chile, and Uruguay, exploring the effects of education over birth cohorts. After presenting descriptive measures of absolute mobility, we use log-linear models to study relative mobility and the mediating role of education. Then, we examine trends in intergenerational class mobility linked to educational levels over cohorts. Finally, counterfactual simulations show the net effects of education on mobility. Results show that intergenerational class mobility across cohorts occurred only for men in Argentina and Chile. Inequality trends in educational opportunities were only present for women. Class returns to education occurred among men in Chile and Uruguay, and women in Argentina. Social fluidity under the mediating effects of education did not show a clear pattern. The claim that educational expansion created more opportunities for intergenerational mobility does not find support in our data.

Patterns of change in the association between socioeconomic status and body mass index distribution in India, 1999-2021.

Body mass index (BMI) is an important indicator of human health. However, trends in socioeconomic inequalities in BMI over time throughout India are understudied. Filling this gap will elucidate which socioeconomic groups are still at risk for adverse BMI values. This repeated cross-sectional study analysed four rounds of India's National Family Health Surveys (1998-1999, 2005-2006, 2015-2016, and 2019-2021). The outcome was BMI categories, measured in kilogram per metres squared (kg/m2), defined as severely/moderately thin (<17.0 kg/m2), mildly thin (17.0-18.4 kg/m2), normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30.0 kg/m2). We examined the prevalence, standardised absolute change, and odds ratios estimated by multivariable regression models by household wealth and levels of education, two important measures of socioeconomic status (SES). The study population consisted of 1 244 149 women and 227 585 men. We found that those in the lowest SES categories were more likely to be severely/moderately thin or mildly thin. Conversely, those in the highest SES groups were more likely to be overweight or obese. The gradients were steepest for wealth, and this was substantiated by the results of regression models for every wave. There has been a decline in the difference in the prevalence of severely/moderately thin or mildly thin between SES groups when comparing the years 1999 and 2021. SES-based inequalities in BMI were smaller in 2021 compared to 1999. However, those in low SES groups were most likely to be severely/moderately thin or mildly thin while those in high SES groups were more likely to be overweight or obese. Future research should explore the pathways that link SES with BMI.